EVALUATING TRIBUNAL DECISIONS TO RELEASE OR DETAIN THOSE NOT CRIMINALLY RESPONSIBLE ON ACCOUNT OF MENTAL DISORDER

Canadians adjudicated Not Criminally Responsible on Account of Mental Disorder (NCR) are detained in forensic psychiatric hospitals under a jurisdictional review board (RB) regulated by the Canadian Criminal Code. Research is limited on whether jurisdictional RB practices uphold the federally legislated balance between public safety and social reintegration. This research investigated whether federal law is applied consistently within the Alberta RB (ARB) system across three phases. Phase One tracked the trajectories and outcomes of NCR individuals through the ARB system, Phase Two determined the predictors of ARB decisions and whether they account for risk or legislatively relevant information, and Phase Three examined forensic risk assessment instruments and their utility to assist forensic decision-making. Instruments included the Level of Service – Case Management Inventory, Historical Clinical Risk Management 20 – Version 3, and the Revised Violence Risk Appraisal Guide. A retrospective archival longitudinal design was used to examine a NCR cohort (n = 109) that entered the ARB system between 2005 and 2010 and their respective hearings (n = 327). Results demonstrated that the ARB aligned their operational and management practices with federal legislation, but unique deviations contributed to novel trajectories and outcomes under RB supervision compared to other provinces. Dispositions varied as a function of risk level and were informed by clinician recommendations. Although risk-relevant information was supplied to the ARB by forensic professionals, key criminogenic risk/need factors as defined by the LS/CMI were absent in most clinical reports. ARB decision-making, however, was still strongly predicted by risk and legislatively relevant information associated with general and violent recidivism. As time under ARB supervision passed and release likelihoods increased, the ARB progressively favoured dynamic over static factors germane to treatment change and risk management. Evidence supported the validity of the study instruments in the appraisal and management of recidivism, especially for violence. Federal duties charged to jurisdictional RBs in the management of NCR populations demands an assiduous consideration of risk and legally relevant information. Forensic risk assessment instruments are reliable and valid aspects of traditional offender programming and the results suggested that they may assist with the appraisal and management of criminal risk anchored in evidence-based practice. Clinical and policy implications of this research for RBs and forensic professionals are discussed

Hopelessness Depression as a Predictive Risk Factor for Recidivism and Survival Time Among Juvenile Offenders

In the United States, there is a high incidence of recidivism among juvenile offenders with mental health disorders. This is a critical social issue facing the public and the Department of Juvenile Justice Administration today. However, research is not clear on the role of psychological factors in recidivism frequency and survival time. The purpose of this study was to examine whether hopelessness depression, as measured by suicidal-ideation, depression-anxiety, anger-irritation, and alcohol-drug use, and offense type, were predictors of recidivism frequency and survival time when controlling for age, gender, and race. The total sample consisted of archival data from 404 juvenile offenders between the ages 13 and 19, who were detainees in the Juvenile Detention facility between January 1, 2009, and December 31, 2012. Data consisted of scores from the Massachusetts Youth Screening Instrument, which is part of the standard intake screening at time of booking. A hierarchical regression analysis indicated a collective significant predictive relationship between age, gender, race, suicidal-ideation, depression-anxiety, anger-irritation, alcohol-drug-use, and recidivism frequency and survival time. Posthoc analyses of variance indicated statistically significant differences in alcohol-drug-use and anger-irritation levels between races. However, the multiple linear regression indicated that suicidal-ideation and depression-anxiety did not significantly predict either recidivism frequency or survival time. Results could enable juvenile justice staff to detect hopelessness depression among juvenile reoffenders at an earlier stage and offer better treatment aimed at reducing future occurrences of youth recidivism, thereby benefitting individuals as well as society

Drug abuse and criminal family records in the criminal history of prisoners

La relación entre el comportamiento criminal y los factores de riesgo, como el registro delictivo familiar y el consumo de drogas, ha sido establecida. Con el objetivo de definir el papel de estos factores de riesgo en el inicio y la evolución de la conducta criminal, se diseñó un estudio de campo con presos. Se aplicó a los datos de 157 reclusos en Villabona (Asturias, España) un análisis de supervivencia relacionado con la edad en que se cometió el primer delito no sancionado y la edad en la que entró por primera vez en la cárcel. Los resultados del análisis muestran que los reincidentes con abuso de drogas se iniciaron en actos delictivos a una edad más temprana (13 años) que los delincuentes primarios (16 años); los reincidentes con antecedentes penales en la familia comenzaron su actividad criminal a una edad anterior (13 años) a los primarios (16 años); Los reincidentes de familias sin antecedentes penales se iniciaban en actos delictivos a los 14 años, mientras que los primarios a los 16; los reincidentes con dependencia a las drogas entran por primera vez en la cárcel antes (19 años) que los primarios. Los delincuentes primarios que no consumen drogas ingresan en la cárcel por primera vez a la edad de 24 años, mientras que los reincidentes a la edad de 19; la primera entrada en prisión de los reincidentes con antecedentes penales de la familia se produce antes (19 años), que en los delincuentes primarios (23 años), y los presos reincidentes sin antecedentes penales de la familia cruzan el umbral de la cárcel por primera vez a una edad más joven (21 años) que los internos primarios (26 años). Las implicaciones de estos resultados pueden orientar una intervención más eficaz contra la delincuencia.The relationship between criminal behavior and the risk factors, family criminal records and drug use, has been firmly established. With the aim of defining the role of these risk factors in the initiation and evolution of criminal behavior, a field study with prison inmates was designed. A survival analysis with the age at which the first unsanctioned crime was committed and the age at which entered by first instance into prison was applied to the data of 157 prison inmates in Villabona (Asturias, Spain). The results of a survival analysis showed that drug abuse re-offenders initiated in criminal acts at an earlier age (13 years) than the primary offenders (16 years); re-offenders from family criminal records began his/her criminal activity earlier (13 years) than primary ones (16 years); re-offenders with non-criminal family records, initiate in criminal acts at 14 years, whereas primary at 16; the recidivist drug abusers enter by first instance into prison earlier (19 years) than the primary ones; non-drug consuming primary offenders enter prison for the first time at the age of 24 whereas recidivists do so at the age of 19; the first entrance into prison of the recidivist with family criminal records occurs early (19 years), than for the primary offenders (23 years); and the recidivist prisoners of non-family criminal records cross the threshold of the prison by first time youngsters (21 years) than the primary inmates (26 years). The implications of these results may lead towards a more effective intervention against crime

Metabolomics improves the histopathological diagnosis of asphyxial deaths: an animal proof-of-concept model

The diagnosis of mechanical asphyxia remains one of the most difficult issues in forensic pathology. Asphyxia ultimately results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence. Histological examination is currently considered the gold standard for CA post-mortem diagnosis. Here we present the comparative results of histopathology versus those previously obtained by 1H nuclear magnetic resonance (NMR) metabolomics in a swine model, originally designed for clinical purposes, exposed to two different CA causes, namely ventricular fibrillation and asphyxia. While heart and brain microscopical analysis could identify the damage induced by CA without providing any additional information on the CA cause, metabolomics allowed the identification of clearly different profiles between the two groups and showed major differences between asphyxiated animals with good and poor outcomes. Minute-by-minute plasma sampling allowed to associate these modifications to the pre-arrest asphyxial phase showing a clear correlation to the cellular effect of mechanical asphyxia reproduced in the experiment. The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA

Causal Pattern Mining in Highly Heterogeneous and Temporal EHRs Data

University of Minnesota Ph.D. dissertation. March 2017. Major: Computer Science. Advisor: Vipin Kumar. 1 computer file (PDF); ix, 112 pages.The World Health Organization (WHO) estimates that the total healthcare spending in the U.S. is around 18\% of its GDP for the year 2011. Even with such a high per-capita expenditure, the quality of healthcare in U.S. lags behind as compared to the healthcare in other industrialized countries. This inefficient state of the U.S. healthcare system is attributed to the current Fee-for-service (FFS) model. Under the FFS model, healthcare providers (doctors, hospitals) receive payments for every hospital visit or service rendered. The lack of coordination between the service providers and patient outcomes, leads to an increase in the costs associated with the healthcare management, as healthcare providers often recommend expensive treatments. Several legislations have been approved in the recent past to improve the overall U.S. healthcare management while simultaneously reducing the associated costs. The HITECH Act, proposes to spend close to \$30 billion dollars on creating a nationwide repository of electronic Health Records (EHRs). Such a repository would consist of patient attributes such as demographics, laboratories test results, vital information and diagnosis codes. It is hoped that this EHR repository will be a platform to improve care coordination between service providers and patients healthcare outcomes, reduce health disparities thereby improving the overall healthcare management system. Data collected and stored in the EHR (HITECH) and the need to improve care efficiency and outcome (ACT) would help to improve the current state of U.S. healthcare system. Data mining techniques in conjunction with EHRs can be used to develop novel clinical decision making tools, to analyze the prevalence and incidence of diseases and to evaluate the efficacy of existing clinical and surgical interventions. In this thesis we focus on two key aspects of EHR data, i.e. temporality and causation. This becomes more important considering that the temporal nature of EHRs data has not been fully exploited. Further, increasing amounts of clinical evidence suggest that temporal nature is important for the development of clinical decision making tools and techniques. Secondly, several research articles hint at the the presence of antiquated clinical guidelines which are still in practice. In this dissertation, we first describe EHR along with the following terminologies : temporality, causation and heterogeneity. Building on this, we then describe methodologies for extracting non-causal patterns in the absence of longitudinal data. Further, we describe methods to extract non-causal patterns in the presence of longitudinal data. We describe such methodologies in the context of Type-2 Diabetes Mellitus (T2DM). Furthermore, we describe techniques to extract simple and complex causal patterns from longitudinal data in the context of sepsis and T2DM. Finally, we conclude this dissertation, by providing a summary of our work along with future directions

Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

Forensic care needs of women diagnosed with a personality disorder

Forensic services have been described as largely based around the needs of men who form the vast majority of in patients. However women’s offending behaviour is quite distinct from men's: they are more likely to have a personality disorder, most commonly borderline personality disorder (BPD) and to have been victims of abuse both as children and adults. Abuse and borderline personality disorder are characterised by problematic relational styles which cause the person great distress. In the forensic services admission is not based upon treatment readiness and it may be difficult for women to form healthy relationships with care staff or their peers. The recovery model has been recently applied to the forensic service and emphasises that improving relationships is a fundamental target. Women in forensic services have said that their peers can help them to feel connected and less stigmatised but also they can find each other's behaviour very disruptive and disturbing. This research set out to develop a theoretical model of the peer relationships of women with BPD in forensic care using grounded theory methodology. 12 women with a diagnosis of BPD were interviewed about their experiences in forensic care. A model was developed that characterises how women's experiences of relating with each other will depend upon ward characteristics and personal readiness for forming relationships. This will determine whether the person is interacting in a survival mode where relationships are superficial or able to attempt to engage at a deeper relational level with their peers. Such engagement may perpetuate relational difficulties, or have the potential to develop recovery through fostering hope, providing encouragement, developing insight and learning new ways to connect with others and manage problems